Hospital Respiratory Team Pioneers Simple Skin Test To Improve Patient Safety

Main Category: Allergy
Also Included In: Infectious Diseases / Bacteria / Viruses;  Respiratory / Asthma
Article Date: 29 Apr 2009 - 6:00 PDT

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Milton Keynes Hospital NHS Foundation Trust is set to pilot an innovative penicillin allergy skin test to improve patient safety and help ensure that further reductions in healthcare associated infections are achieved.

Patients with suspected penicillin allergy are typically treated with alternative antibiotics. However, research shows that penicillin allergies are over-reported by patients, often because certain experiences are easily mistaken for true allergy. Studies have shown that 80 to 90 percent of patients who report a penicillin allergy are not actually allergic to the medication. This means that penicillin is withheld from many patients who could safely take the medication or its derivatives.

The Respiratory Team at Milton Keynes Hospital is set to use a simple penicillin allergy skin test to effectively identify whether or not patients have a true penicillin allergy.

This is important because some broad spectrum penicillin alternatives can make it more likely that a patient may develop Clostridium difficile (C.diff) or MRSA bacteraemia.

Skin testing is reliable and useful to rule out penicillin allergy in most patients who have a history of previous reactions. Advance Nurse Practitioners will carry out the allergy test when required after careful history-taking, and the results will be available in 3-30 minutes following testing.

Dr Rahul Mukherjee, Respiratory Consultant at Milton Keynes Hospital, said: "Patients with a self-reported history of penicillin allergy are limited from using drugs containing penicillin, even though their history may be vague and unconfirmed.

"Often, when a patient states that he or she is allergic to penicillin, a careful history-taking and testing would prove that this is not really the case. Unfortunately, it is difficult to determine who is truly allergic, and often the simplest approach is adopted whereby penicillin is avoided.

"The problem is that the use of broad-spectrum antibiotics is a predominant risk factor for Clostridium difficile (C.diff). Reductions in incidence of C. diff can be achieved by avoiding as much as possible the high-risk antibiotics when treating common infections, by using penicillin.

"In small numbers, C. diff does not result in significant disease. However, antibiotics, especially those with a broad spectrum of activity, cause disruption of normal intestinal flora, leading to an overgrowth of C.diff, which flourishes under these conditions."

"The skin test that we are piloting is simple and safe. The investigation will put paid to respiratory patients unnecessarily being prescribed antibiotics."

The Respiratory Team deals with a number of lung diseases and respiratory problems that require medication (such as penicillin or antibiotics) to tackle a variety of bacterial infections, including Chronic Obstructive Pulmonary Disease (COPD), bronchiectasis and tuberculosis (TB).

The innovative testing project is just one of the ways that Milton Keynes Hospital is effectively tacking healthcare associated infections (HAIs). MRSA levels are consistently amongst the lowest in the country and over the past year the Trust has continued to make steps towards preventing all avoidable infections. The total number of MRSA bacteraemia cases reported over 2008/09 was 6.

Clostridium difficile (C.diff) rates have fallen over the past two years. Cases of C.diff fell by two thirds over 2008/09 at Milton Keynes Hospital compared with the previous year, with a total of 43 incidents.

The penicillin allergy skin test is already being used by some specialist hospitals world wide, but is not commonplace in the UK.

By using the allergy skin test and reducing the unnecessary prescribing of antibiotics, resistance to antibiotics is being reduced.

Benefits of the allergy test include:

- Fewer antibiotics means that there is a lower likelihood of strains of bacteria and diseases developing that are antibiotic resistant.
- Better prescribing for patients.

Notes

- Treatment with cefuroxime, cefotaxime and quinolones (a family of synthetic broad-spectrum antibiotics) or other antibiotics can alter the normal bacteria flora of the colon and permit overgrowth of C. difficile or develop resistance to MRSA.

- Allergic reactions vary from slight rashes to severe anaphylactic immune reactions. The safety of patients is the priority of Milton Keynes Hospital at all times, and all examinations carried out regarding allergies are professionally conducted and supervised.

Source
Milton Keynes Hospital NHS Foundation Trust